The U.S. Departments of Labor (DOL), Health and Human Services (HHS), and Treasury, recently issued Frequently Asked Questions (FAQ) about the Consolidated Appropriations Act, 2021 Implementation (Part 67). These FAQs address certain issues in implementing Title I provisions (the No Surprises Act) because of a Texas federal court decision (TMA III). A major purpose of the FAQs is to inform plans, insurers, and parties to independent dispute resolution (IDR) disputes under the No Surprises Act that it will extend enforcement relief provided in previously issued FAQs (Part 62) to items and services provided before November 1, 2024.

Under these FAQs and previous FAQs, the agencies advised plans and insurers to calculate qualifying payment amounts (QPAs) using a good faith, reasonable interpretation of the No Surprises Act and regulations remaining valid after TMA III. However, the agencies also announced that they would exercise discretion in enforcement for plans, insurers, and parties to IDR disputes who calculated QPAs according to interim final regulations and guidance that was in effect immediately before TMA III. While the agencies originally extended this relief until May 1, 2024, that relief will remain in effect until November 1, 2024.

The agencies stated that they will continue to assess the status of QPA calculations. Plans and insurers provided significant feedback indicating they need additional time to recalculate QPAs according to the guidance remaining intact after TMA III. However, the agencies do not foresee extending the existing discretionary enforcement relief again.

Meanwhile, the IDR portal remains open for all disputes, with updates concerning portal availability and process changes posted on the CMS website.

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